Laparoscopic myotomy without fundoplication in patients with achalasia

Objective: Analysis of outcome after laparoscopic myotomy for achalasia. Design: Prospective audit. Setting: Teaching hospital, Sweden. Subjects: All patients with achalasia who had a laparoscopic myotomy without a simultaneous fundoplication. Interventions: Questionnaire, pH-measurements, radiography and manometry. Main outcome measures: Operative and postoperative complications and reoperations. Results: Twenty-one patients were scheduled for laparoscopic myotomy. Three were converted to open operations, and four were reoperated on transabdominally for persistent or recurrent symptoms. All patients were satisfied afterwards. Follow-up in 14 patients, after a median of 22 months (range, 6-40), included manometry, questionnaire, and 24-hour pH measurements, and showed significant reduction in the lower oesophageal sphincter pressure together with relief of symptoms. Three patients had reflux symptoms and abnormal pH readings. An additional five patients had abnormal pH measurements but no symptoms of reflux. Conclusions: Keller myotomy can safely be done laparoscopically. Whether a simultaneous antireflux procedure is needed remains to be seen.